Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer
- PMID: 26761625
- PMCID: PMC4786452
- DOI: 10.1056/NEJMoa1510795
Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer
Abstract
Background: Among patients in whom childhood cancer was diagnosed in the 1970s and 1980s, 18% of those who survived for 5 years died within the subsequent 25 years. In recent decades, cancer treatments have been modified with the goal of reducing life-threatening late effects.
Methods: We evaluated late mortality among 34,033 patients in the Childhood Cancer Survivor Study cohort who survived at least 5 years after childhood cancer (i.e., cancer diagnosed before the age of 21 years) for which treatment was initiated during the period from 1970 through 1999. The median follow-up was 21 years (range, 5 to 38). We evaluated demographic and disease factors that were associated with death from health-related causes (i.e., conditions that exclude recurrence or progression of the original cancer and external causes but include the late effects of cancer therapy) using cumulative incidence and piecewise exponential models to estimate relative rates and 95% confidence intervals.
Results: Of the 3958 deaths that occurred during the study period, 1618 (41%) were attributable to health-related causes, including 746 deaths from subsequent neoplasms, 241 from cardiac causes, 137 from pulmonary causes, and 494 from other causes. A reduction in 15-year mortality was observed for death from any cause (from 12.4% in the early 1970s to 6.0% in the 1990s, P<0.001 for trend) and from health-related causes (from 3.5% to 2.1%, P<0.001 for trend). These reductions were attributable to decreases in the rates of death from subsequent neoplasm (P<0.001), cardiac causes (P<0.001), and pulmonary causes (P=0.04). Changes in therapy according to decade included reduced rates of cranial radiotherapy for acute lymphoblastic leukemia (85% in the 1970s, 51% in the 1980s, and 19% in the 1990s), of abdominal radiotherapy for Wilms' tumor (78%, 53%, and 43%, respectively), of chest radiotherapy for Hodgkin's lymphoma (87%, 79%, and 61%, respectively), and of anthracycline exposure. Reduction in treatment exposure was associated with reduced late mortality among survivors of acute lymphoblastic leukemia and Wilms' tumor.
Conclusions: The strategy of lowering therapeutic exposure has contributed to an observed decline in late mortality among 5-year survivors of childhood cancer. (Funded by the National Cancer Institute and the American Lebanese-Syrian Associated Charities.).
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4786452/bin/nihms-746338-f0001.gif)
![Figure 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4786452/bin/nihms-746338-f0002.gif)
Comment in
-
Reduction in Late Mortality after Childhood Cancer.N Engl J Med. 2016 Jul 21;375(3):290-2. doi: 10.1056/NEJMc1604184. N Engl J Med. 2016. PMID: 27468077 No abstract available.
-
Reduction in Late Mortality after Childhood Cancer.N Engl J Med. 2016 Jul 21;375(3):289-90. doi: 10.1056/NEJMc1604184. N Engl J Med. 2016. PMID: 27468078 No abstract available.
Similar articles
-
Temporal patterns in the risk of chronic health conditions in survivors of childhood cancer diagnosed 1970-99: a report from the Childhood Cancer Survivor Study cohort.Lancet Oncol. 2018 Dec;19(12):1590-1601. doi: 10.1016/S1470-2045(18)30537-0. Epub 2018 Nov 8. Lancet Oncol. 2018. PMID: 30416076 Free PMC article.
-
Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort.Lancet Oncol. 2014 Jul;15(8):841-51. doi: 10.1016/S1470-2045(14)70265-7. Epub 2014 Jun 19. Lancet Oncol. 2014. PMID: 24954778 Free PMC article.
-
Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study.J Clin Oncol. 2009 May 10;27(14):2328-38. doi: 10.1200/JCO.2008.21.1425. Epub 2009 Mar 30. J Clin Oncol. 2009. PMID: 19332714 Free PMC article. Review.
-
Cause of mortality in 5-year survivors of childhood cancer.Pediatr Blood Cancer. 2007 Jun 15;48(7):723-6. doi: 10.1002/pbc.21114. Pediatr Blood Cancer. 2007. PMID: 17226844 Review.
-
Mortality among 5-year survivors of cancer diagnosed during childhood or adolescence in British Columbia, Canada.Pediatr Blood Cancer. 2007 Apr;48(4):460-7. doi: 10.1002/pbc.20922. Pediatr Blood Cancer. 2007. PMID: 16767717
Cited by
-
Using an mHealth approach to collect patient-generated health data for predicting adverse health outcomes among adult survivors of childhood cancer.Front Oncol. 2024 May 10;14:1374403. doi: 10.3389/fonc.2024.1374403. eCollection 2024. Front Oncol. 2024. PMID: 38800387 Free PMC article.
-
Dental management of long-term childhood cancer survivors: a systematic review.Eur Arch Paediatr Dent. 2024 May 21. doi: 10.1007/s40368-024-00896-5. Online ahead of print. Eur Arch Paediatr Dent. 2024. PMID: 38773051
-
Multilevel Social Determinants of Patient-Reported Outcomes in Young Survivors of Childhood Cancer.Cancers (Basel). 2024 Apr 25;16(9):1661. doi: 10.3390/cancers16091661. Cancers (Basel). 2024. PMID: 38730616 Free PMC article.
-
Chronic Health Conditions and Longitudinal Employment in Survivors of Childhood Cancer.JAMA Netw Open. 2024 May 1;7(5):e2410731. doi: 10.1001/jamanetworkopen.2024.10731. JAMA Netw Open. 2024. PMID: 38728029 Free PMC article.
-
Evolving Evidence-Based Value Assessment of One-Time Therapies: Tisagenlecleucel as a Case Study.Appl Health Econ Health Policy. 2024 Apr 29. doi: 10.1007/s40258-024-00882-4. Online ahead of print. Appl Health Econ Health Policy. 2024. PMID: 38683438
References
-
- Ries LG, Pollack ES, Young JL., Jr. Cancer patient survival: Surveillance, Epidemiology, and End Results Program, 1973-79. J Natl Cancer Inst. 1983;70:693–707. - PubMed
-
- Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2012. National Cancer Institute; Bethesda, MD: 2014.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical